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Clin Infect Dis. Author manuscript; available in PMC 2018 May 23. Published in final edited form as: Clin Infect Dis. 2018 May 17; 66(11): 1733–1741. doi:10.1093/cid/cix1071.
Massive Iatrogenic Outbreak of Human Immunodeficiency Virus Type 1 in Rural Cambodia, 2014–2015
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François Rouet1,a, Janin Nouhin1,a, Du-Ping Zheng2, Benjamin Roche3, Allison Black4, Sophearot Prak1, Marie Leoz5, Catherine Gaudy-Graffin6, Laurent Ferradini7, Chandara Mom8, Sovatha Mam8, Charlotte Gautier1, Gérard Lesage6, Sreymom Ken1, Kerya Phon1, Alexandra Kerleguer1, Chunfu Yang2, William Killam9, Masami Fujita7, Chhivun Mean8, Didier Fontenille1, Francis Barin6, Jean-Christophe Plantier5, Trevor Bedford4, Artur Ramos9, and Vonthanak Saphonn10 1Unité
VIH/Hépatites, Institut Pasteur du Cambodge (IPC), Phnom Penh, Cambodia
2International
Laboratory Branch (ILB), Centers for Disease Control and Prevention (CDC),
Atlanta, USA 3UMR
IRD 224-CNRS 5290-Université de Montpellier, Maladies Infectieuses et Vecteurs : Ecologie, Génétique, Evolution et Contrôle (MIVEGEC), Montpellier, France
4Fred
Hutchinson Cancer Research Center, Seattle, USA
5Centre
National de Référence (CNR) sur le VIH, Laboratoire Associé, EA2656, Rouen University Hospital, Rouen, France
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6Centre 7World
National de Référence (CNR) sur le VIH and INSERM Unité 966, Tours, France
Health Organization (WHO), Phnom Penh, Cambodia
8National
Center for HIV/AIDS, Dermatology and Sexual Transmitted Diseases (NCHADS), Phnom Penh, Cambodia 9Division
of Global HIV/AIDS, Centers for Disease Control and Prevention (CDC), Phnom Penh, Cambodia
10University
of Health Sciences (UHS), Phnom Penh, Cambodia
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Corresponding author: F. Rouet, Unité VIH/Hépatites, Institut Pasteur du Cambodge, 5 boulevard Monivong, BP 983 – Royaume du Cambodge, Tel: +855 (0)85 235 983 - Fax: +855 (0)23 725 606 -
[email protected]. Alternate corresponding author: J. Nouhin, Unité VIH/Hépatites, Institut Pasteur du Cambodge, 5 boulevard Monivong, BP 983 – Royaume du Cambodge, Tel: +855 (0)89 920 219 - Fax: +855 (0)23 725 606 -
[email protected]
Author contributions. FR, JN, SP, DF, AR, and VS conceived the study. FR, JN, DZ, SP, CGG, CM, SM, CG, GL, SK, KP, AK, and CY generated and managed the data. FR, JN, BR, AB, SP, ML, LF, WK, FB, MF, CM, JCP, and TB contributed to the data analysis. FR, JN, and AR contributed to writing the first draft of the paper. Disclaimer. The content is solely the responsibility of the authors, and the findings and conclusions in this study do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Potential conflicts of interest. We declare no competing interests.
Rouet et al.
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Background—In 2014–2015, 242 individuals aged 2–89 were newly HIV-1 diagnosed in Roka, a rural commune in Cambodia. A case-control study attributed the outbreak to unsafe injections. We aimed to reconstruct the likely transmission history of the outbreak. Methods—We assessed in 209 (86.4%) HIV-infected cases the presence of hepatitis C and B viruses (HCV, HBV). We identified recent infections using antibody (Ab) avidity testing for HIV and HCV, and HBcIgM Ab for HBV. We performed evolutionary phylogenetic analyses of viral strains. Geographical coordinates and parenteral exposure through medical services provided by an unlicensed health care practitioner were obtained from 193 cases and 1499 controls during interviews.
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Results—Cases were co-infected with HCV (78.5%) and HBV (12.9%). We identified 79 (37.8%) recent (
